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This Program information provided by the Adolescent Health Section of the Office of Family Health Services.
School Based Health Centers: Funding and OperationsProgram e-mail: SBHC.program@state.or.us Funding
Oregon’s School-Based Health Center (SBHC) program has benefited from over 20 years of support by the Oregon Department of Human Services and the Oregon Legislature. What began with an initial commitment of $212,000 to partially fund five SBHCs grew to a commitment of $5,839,000 to support 55 certified SBHCs and up to 12 planning sites in the 2009-2011 biennium.
Prior to July 1 2005, SBHCs were historically funded through a competitive grant process wherein the successful SBHCs in the state received grants of $52,619 per SBHC, while the remaining 24 that grew over the years received no direct state funds. All centers maintained similar levels of care, but without State compensation. This created considerable inequity statewide. However, when there was a legislative interruption of funds in February 2003 due to the failure of Measure 28, state-funded SBHCs were more severely impacted than those clinics that were less reliant on state dollars. As state dollars were fully reinstated in Fall 2003, the opportunity arose to re-evaluate the funding formula. After discussions with the Oregon School-Based Health Care Network and the Conference of Local Health Officials, a new funding formula emerged that aligned SBHCs with the public health delivery system for stability and ongoing support, while leveling most inequities.
authority (LPHA). The LPHA is provided funds to support SBHCs and SBHC systems based on the number of state certified SBHCs in the county and the availability of legislatively approved dollars. The specific expenditure of the funds is a local level decision between the LPHA and local partners.
The 2005 funding to LPHAs was based on a range formula: if there were 1-2 certified SBHCs in the county, the LPHA received $60,000/yr; 3-5 SBHCs they receive $120,000/year; 6-9 SBHCs they receive $180,000; and 10 centers and over they receive $240,000/year. This 2005 range funding formula requires an increasing local investment in the development of an SBHC system as the total number of centers increase, leading to questions regarding it’s solvency with both SBHC expansion and sustainability.
During the 2007-2009 biennium, the largest expansion in Oregon’s SBHC history occurred with 18 planning site in counties with and without existing centers. Working within the 2005 range funding formula, many counties began to reevaluate the sustainability of their current centers when presented with the opportunity to open new centers. This initiated the discussion of the current effectiveness of the 2005 range formula within the context of sustainability and expansion. In response, in January 2009, the funding workgroup convened to (1) revisit how State General Fund dollars support the overall mission of SBHCs in Oregon; (2) examine the effectiveness of the current funding formula in the present times; and (3) explore other funding formula models to improve sustainability and expansion efforts with the possibility of recommending a revised formula.
Based on the workgroup discussions a new funding formula was implemented July 1, 2009 stating:
For more details on:
Operations
The average SBHC in Oregon costs an estimated $150,000-250,000/year to operate. Each of these state dollars is used to leverage about $3-4 local dollars. Local dollars may come from schools, school districts, county health departments, county commissioners, hospitals, community providers, local businesses and individuals, grants, and general fundraising and billing. However, stable sources of ongoing revenue and operational funds remain a significant concern for most SBHCs.
As the number of SBHCs in Oregon continues to grow, the state program office works with local partners to help identify ways to maximize efficiency and strategically plan for improved sustainability. Some efforts may include advocating for reimbursement of early intervention and more prevention services as provided in SBHCs, and identify best practices for public/private partnerships supporting SBHCs.
For more information regarding the cost and revenue details of Oregon SBHCs please read Planning and Sustaining a School-Based Health Center: Cost and Revenue Findings from Oregon.
For more information about planning a new School-Based Health Center, please view the School-Based Health Center RFP or visit SBHC Planning |
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